Insurance Providers

From Hixny’s very beginning, health insurers have been key to defining how we bring the healthcare community together in the sharing of high-quality data.

Highlights

For years, the primary goal of our health insurance colleagues was to see high-quality information flowing in ways that could save them time by overcoming the clinical/claims information divide.

That’s why Hixny is among the first organizations nationally to develop both the solutions and the data quality protocols necessary to bridge the gap and meet NCQA reporting standards.

Here’s what that means for you.

Data use approved. No patient consent needed.

Hixny is able to share clinical data from patients with whom you already have a relationship. You provide the roster; we deliver the matching data.

Medicare and Medicaid compliant.

You’ll have all the data required to confirm value-based reimbursements to providers participating with your company, as well as expected patient care.

Case manager approved.

Although case managers work from a roster-driven report, they benefit from the same insights, gap data, and patient background as care managers in the clinical space.

High integrity. Maximum security.

The patient data you see is complete and high-quality, meeting NCQA standards for use in HEDIS reviews —and it’s under bank- and military-grade security.

Can we really use data from Hixny for HEDIS® reporting?

Yes. In fact, all health insurance companies in Hixny’s traditional HIE coverage area do just that.

Since 2020, Hixny has maintained NCQA Data Aggregator Validation (DAV), which ensures that data shared by healthcare providers through the SHIN-NY adheres to HL7 C-CDA R2.1 standards for consistency and meets accuracy and integrity benchmarks.

Insurers can then confidently submit this as supplemental data for HEDIS reporting, nearly eliminating the need for “chart chases” through participating providers’ offices. Most insurers have seen HEDIS scores improve using Hixny, while several have seen increases in Medicare STAR ratings, all of which translates to increased revenue.

And we’re not stopping there. In 2025, Hixny became the first organization of its kind, nationally, to earn validation for health-related social needs data.

Hixny in Real Life

Capital District Physicians’ Health Plan, Inc.

For Capital District Physicians’ Health Plan, Inc. (CDPHP®), HEDIS reporting has always been necessary. The health plan’s longstanding, proactive approach to gathering data from patient records is well-known among participating providers. And plan analysts expected to gain efficiency by using Hixny’s NCQA-validated data.

In 2023, they were shocked to find they also gained accuracy and improved their capture of provider performance against critical HEDIS quality measures:

  • 7% more short-term follow-ups for newly initiated care were reported, from a baseline of 40%
  • 4% more flu vaccines showed through Hixny than were previously known from pharmacy claims—and reported childhood immunizations increased, too
  • 12% more patients were reported as having controlled high blood pressure—which rose to 14% more among patients who also had diabetes

Among cancer screening reports:

  • Breast cancer screening rose 19% with 125 exclusions identified
  • Colon cancer screening rose 12% with 682 exclusions identified
  • Cervical cancer screening rose 3% with 375 exclusions identified

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